Study finds uncommonly assessed variables linked to schizophrenia functional outcomes

Baseline variables not routinely assessed and targeted by intervention programs in community mental health services were linked to functional outcomes at follow-up for schizophrenia, according to study results published in JAMA Psychiatry.

“The available evidence does not enable the drawing of solid conclusions regarding the variables associated with real-life functioning in people with schizophrenia across time owing to several methodological flaws: (1) most studies have modest sample sizes (N 150); (2) the assessment of cognitive functioning, disorganization, and negative symptoms is not always carried out using state-of-the-art instruments (eg, second-generation assessment instruments for negative symptoms, such as the Brief Negative Symptom Scale, or comprehensive cognitive assessment batteries, such as the Measurement And Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery); (3) social cognition impairment is not always evaluated; (4) most studies explore global functioning or only 1 of the real-life functioning domains, which might have distinct determinants; and (5) functional capacity is seldom included,” Armida Mucci, MD, of the department of psychiatry at the University of Campania “Luigi Vanvitelli” in Italy, and colleagues wrote.

In the current multicenter prospective cohort study, the researchers aimed to address some of these limitations, as well as to assess potential associations between baseline illness-related variables, personal resources and context-related factors and work skills, interpersonal relationships and everyday life skills at 4-year follow-up. They analyzed data of 618 participants across 24 Italian university psychiatric clinics or mental health departments, all of whom enrolled in a cross-sectional study and were contacted for reassessment after 4 years. Participants were community-dwelling and stable individuals who met criteria for schizophrenia according to the Structured Clinical Interview for DSM-IV. Measures included psychopathology, social and nonsocial cognition, functional capacity, personal resources and context-related factors; real-life functioning served as the main outcome.

The researchers used structural equation modeling, multiple regression analyses and latent change score modeling to identify variables linked to real-life functioning domains at follow-up and with changes from baseline in these domains.

Results showed associations between five baseline variables and real-life functioning at follow-up. These variables were neurocognition with everyday life and work skills, avolition with interpersonal relationships, positive symptoms with work skills and social cognition with work skills and interpersonal functioning. After controlling for baseline functioning, these variables accounted for the variability of functioning at follow-up, according to results of multiple regression analyses. The researchers noted associations between higher neurocognitive abilities and improvement of everyday life and work skills, social cognition and functional capacity, as well as better baseline social cognition with improvement of work skills and interpersonal functioning and better everyday life skills with improvement of work skills, according to the latent change score model.

“People with schizophrenia, even in advanced stages of the disorder, require a detailed assessment of their psychopathological and functional characteristics,” Mucci and colleagues wrote. “If data relevant to the individual characteristics in all mentioned domains are available, then personalized and integrated management programs can be implemented, their impact can be constantly monitored and changes to ongoing programs can be introduced to meet new or still unmet needs. The key roles of social and nonsocial cognition (which, as shown by our data, are associated with different domains of real-life functioning) and of practical skills to meet the demands of everyday life strongly support the adoption of cognitive training interventions in routine mental health care, in particular those with a focus on the transfer of cognitive skills to real-life functioning, combined with personalized psychosocial interventions aimed to promote independent living.”